BACKGROUND The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. METHODS We compared five computer-assisted mandibular reconstructions with 15 conventional mandibular reconstructions performed using vascularized iliac crest bone grafts. Based on preoperative cone beam computed tomography (CBCT) or CT data imported into the specific surgical planning software, a surgical guide was designed by rapid prototyping that helped to exactly translate the virtual surgery plan into the operation site whereby it fit uniquely to the iliac donor site. The ischemic time of the graft was measured intraoperatively and the difference between the amount of bone removed and the amount of bone required was determined. In addition, 3 months after surgery patients had to score the esthetics of their outer appearance using a visual analog scale. RESULTS In all patients the graft fit perfectly into the mandibular defect without major adjustments. The time for the shaping process of the transplant and the ischemic time were shorter than in the conventional grafting procedure. The virtual plan reduced the amount of bone removed to the required volume. The patients who underwent computer-assisted reconstruction had a higher degree of satisfaction with their outer appearance. CONCLUSIONS Our clinical experience and the collected data suggest that the described method is very promising for optimizing the surgical result of mandibular reconstructions using iliac crest bone grafts and achieving an excellent esthetic outcome. METHODS This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.